Billing Specialist

Job Description

Job Description

POSITION SUMMARY:

The Billing Specialist will perform a range of responsibilities requiring data analysis, critical evaluation, and sound judgment, including maintaining billing software, appealing denied claims, and recording late payments .

KEY FUNCTIONS & RESPONSIBILITIES:

• Review and research forms documenting patient visit information, making corrections to amounts due from patients and insurance as needed.
• Contact insurance companies to verify patient coverage, determine schedules of payors, and obtain detailed information regarding benefits. Compute total bills showing amounts to be paid by both insurance and patients.
• Examine patient bills for accuracy and completeness, obtaining any missing information to ensure proper billing.
• Prepare, review, and transmit claims using billing software, including both electronic and paper claim processing.
• Follow up on unpaid claims within standard billing cycle timeframes.
• Respond to all patient and insurance inquiries related to assigned accounts in a timely and professional manner.
• Audit claims, accounts, payers, and vouchers; prepare adjustment reports to substantiate individual transactions and resolve payment issues.
• Provide support to clinics and attend external meetings as required.
• Review, investigate, and correct errors, documenting inconsistencies in practice management system entries, documents, and reports.
• Maintain working knowledge of HCPCS, CPT, ICD, and revenue codes using appropriate manuals and resources (both hard-copy and online) to facilitate accurate billing.
• Achieve productivity goals as established by management.
• Perform essential duties, assist colleagues, and complete other tasks assigned by management upon finishing own assignments.
• Coordinate communications with payers to ensure accurate billing practices, enhance reimbursement opportunities, achieve cash collection targets, and maintain accounts receivable (A/R) over 120 days at or below target levels.

EDUCATION AND EXPERIENCE:

• Minimum of a high school diploma required; Associate’s (AA) or Bachelor’s (BS) degree preferred, or equivalent experience.
• Medical Billing/Coding certification is a plus.
• Minimum of two (2) years of experience as a medical biller or coder required.
• Proficient in Microsoft Office; strong organizational, verbal, and written communication skills.

OTHER SKILLS AND ABILITIES:

• Strong attention to detail with the ability to thrive in a fast-paced environment.
• Experience and/or knowledge of FQHC billing guidelines and procedures preferred.
• Solid understanding of billing software and electronic medical record (EMR) systems.
• Maintain current knowledge of insurance guidelines, including Medicare and state Medicaid programs.
• Proficient in CPT and ICD-10 coding.
• Strong multitasking abilities and effective time management skills.
• Excellent written and verbal communication skills.
• Outstanding problem-solving and organizational abilities.
• Advanced computer literacy and strong interpersonal skills.
• Thorough understanding of the full revenue cycle, including processing claims, resolving denials, maximizing reimbursement, and managing accounts receivable (A/R).
• Knowledge of billing, reimbursement procedures, and third-party regulations.
• Experience with eClinicalWorks (eCW) is a plus.
• Familiarity with healthcare governing agency policies and procedures.
• Knowledge of medical terminology.
• Strong interpersonal and human relations skills.
• Ability to work independently as well as collaboratively within a team.
• Comfortable working in a fast-paced environment.
• Skilled in interpreting accounts and records, developing spreadsheets, and generating reports.
• Capable of performing basic bookkeeping and compiling statistical data.
• Proficient in operating a personal computer and various office equipment.
• Ability to prepare reports and maintain organized records and files.
• Skilled in extracting relevant data from conversations and documents.
• Committed to maintaining confidentiality and ensuring the privacy and security of protected health information in compliance with HIPAA requirements.
• Demonstrates and promotes a standard of excellence in all duties and interactions with patients, colleagues, and external contacts.
• Performs other duties or special projects as assigned.

Why work at CCI?

• Extensive benefits plan including PTO
• 403B Retirement Plan
• Tuition reimbursement opportunities
• Continuing education assistance; can be used toward obtaining certifications, renewal of certifications, or possible conference attendance.
• Our providers are insured for malpractice under FTCA.

Equal Employment Opportunity (EEO)

CCI Health Services does not unlawfully discriminate based on race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer related or genetic characteristics or any genetic information), marital status, sex, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. All personnel decisions are to be administered in accordance with this policy and in compliance with applicable federal and state law, including, but not limited to, decisions regarding recruitment, selection, training, promotion, compensation, benefits, transfers, lay-offs, tuition assistance, and social and recreational programs.

The CEO & President of CCI and all managerial personnel are committed to this policy and its enforcement. Employees are directed to bring any violation of this policy to the immediate attention of their supervisor, Human Resources, or the CEO & President. Any employee who violates this policy or knowingly retaliates against an employee reporting or complaining of a violation of this policy, shall be subject to immediate corrective action, up to and including termination of employment. Complaints brought under this policy will be promptly investigated and handled with due regard for the privacy and respect of all involved.